Do you know what infectious disease you're supposed to be the most worried about today? Is it the "superbug" that broke out in an LA hospital last month, possibly exposing over a hundred patients? Or is it the early seasonal uptick in cases of Middle Eastern Respiratory Syndrome (MERS) in Saudi Arabia that has the global epidemiological community buzzing? Or maybe it's the continuation of measles outbreaks all over the country due to spotty immunization coverage. You might also still be reasonably concerned about Ebola (and no, it's not over yet, despite a downturn in news coverage and an encouraging slowdown in new cases in some affected areas). It's hard to keep track of the latest terrifying deadly disease. And that's a problem in more ways than one.
When attention is cast upon a specific disease threat, usually as a result of media reports of a new outbreak happening somewhere, a lot gets set in motion. The more deadly or horrifying the disease, the swifter public reaction seems to be. The resulting social media commentary, news stories, hot takes by leading public figures and government officials, and public outcry over the speed or effectiveness of the response can - and often does - help to generate an influx of additional public health funding and collaboration around a particular disease threat. Public attention often spurs a renewed governmental interest in sponsoring more scientific research on new or more effective treatment and prevention measures.
So far, all of this sounds fairly positive. Promoting and harnessing the public's fears of deadly disease works. Media stories scare us and then we do something. Public health campaigns are often actively designed to tap into this anxiety. You've probably seen one of the new antismoking campaign posters from the US CDC. They provoke a visceral reaction. In fact, fear arousal is such an effective technique in public health that there's even a standard term for it: fear appeals.
But there's a hidden underbelly to trying to tap into our collective anxiety: Fear is reactive, not proactive. And that's not very good for prevention since a reaction is temporary. A reaction is a response to a stimulus and it doesn't necessarily produce sustained actions or long-term changes once the stimulus disappears. It's also difficult to control the level of emotional reaction. Fear is a tricky emotion to manage.
Once the public's fear is unleashed, it's often difficult to rein back in. Research has shown that appealing to fear when there is high risk only works if there is an effective way to avoid or halt the disease threat. This works well with things like cancer and anti-smoking campaigns, but less well with something like the flu. If you make people very afraid of something it will be hard to avoid getting - like SARS - the messaging you're using won't be nearly as effective. But by the same token, if the threat is perceived as less serious or irrelevant, the public is less likely to take any notice at all, largely ignoring it. This was the situation during the 2009 H1N1 influenza pandemic after it became clear that the virus was milder than previously thought. Piles of vaccines went unused that year because people simply ignored the advice to get the shot. There's also a risk of scaring people so much that it causes a complete avoidance of the topic altogether - engendering a "head in the sand" approach, if you like. In sum, manipulating fears in relationship to disease threats often backfires.
But stoking fears related to serious disease threats might be causing a bigger problem for public health in the long-haul. Reacting to successive outbreaks - Ebola, MERS, MRSA - might leave us more vulnerable to the next "big one". By focusing attention and funding on specific diseases, we ignore the real global problems of inadequate health infrastructures, low levels of trained staff, and less-than ideal access to resources that promote everyday health. Routine use of fear appeals in public health campaigns and media coverage of disease threats might also be negatively affecting our collective future health by overloading us with more worries than we can effectively cope with. It ends up desensitizing us to all future threats.
Most people understand that disease outbreaks are bad news for everyone and that diseases know no borders. They also generally want to help their fellow human beings, especially when they're suffering from a terrible disease. So instead of fear mongering, or using fear to garner public support for public health programs and responses, maybe we should start appealing to common sense. We shouldn't always need to be terrified into action.